Contents
Maggot Therapy and the Global Wound Burden 1
Why a Book on Maggot Therapy? 5
2. Living with a Chronic Wound 17
Wellbeing in People Living with Chronic Wounds 18
Spiritual/Cultural Wellbeing 26
How People with Chronic Wounds Seek, Access, and Experience Care 27
3. Wound Aetiologies, Patient Characteristics, and Healthcare Settings Amenable to Maggot Therapy 39
Wounds Amenable to Maggot Therapy 40
Population and Patient Characteristics 49
4. Indications, Contraindications, Interactions, and Side-effects of Maggot Therapy 63
Indications for Maggot Therapy 64
Contraindications and Relative Contraindications for Maggot Therapy 67
Interactions between Maggot Therapy and Other Treatment Modalities 68
Warnings and Adverse Events Associated with Maggot Therapy 69
5. Medicinal Maggot Application and Maggot Therapy Dressing Technology 79
Maggot Therapy Dressings—Past and Present 80
Dressing Changes, Maintenance & Repair 88
Dressing Duration and Removal 89
Reapplication or Follow-up Treatment? 92
6. Clinical Integration of Maggot Therapy 97
Institutional and Professional Considerations 99
Regulatory Considerations, Cost and Reimbursement 100
Organisational Considerations 109
Part 2: Therapeutic Principles 119
7. The Natural History of Medicinal Flies 121
Life-cycle and Developmental Traits of Calliphorid Flies 127
Environmental Factors Affecting Calliphorid Fly Behaviour 130
Calliphorid Interactions with Humans and Domesticated Animals 132
Efficacy of Maggot Therapy for Wound Debridement 144
The Feeding Process and Maggot Enzymatic Action 145
Identification of Maggot Enzymes in Debridement 146
9. The Antimicrobial Activity of Medicinal Maggots 153
Historical Investigations into the Antimicrobial Activity of Maggots 154
Resurgent Interest in Antibacterial Bioactivity from Maggots 155
Evidence for the Antimicrobial Activity of Medicinal Maggots 157
The Antimicrobial Compounds in Maggot Excretions and Secretions 160
10. Maggot-assisted Wound Healing 175
Early Studies on Maggot-led Healing 176
Randomised Controlled Trials on Wound Healing Using Maggots 178
Scientific Mechanisms by Which Maggots Promote Wound Healing 179
11. Bioprospecting and Testing of New Fly Species for Maggot Therapy 195
Bioprospecting for Medicinal Fly Species 196
Preclinical Research Protocols 203
Clinical Use and Commercial Production 220
Part 3: Production of Medicinal Maggots 235
12. Laboratory and Insectary Infrastructure and Equipment 237
Production Laboratory Typology 239
Building and Space Requirements 244
13. Fly Colony Establishment, Quality Control and Improvement 257
Taxonomic Identification and Confirmation of Species 266
Domestication of Fly Stock 275
14. Medicinal Maggot Production 289
How to Care for Adult Flies 290
Disinfection of Medicinal Maggots 303
Supply Management and Perishability of Medicinal Maggots 308
Scheduling of Production Activities 310
Occupational Health and Safety 313
Sustainable Production and Waste Management 314
Medicinal Maggot Production in Healthcare Settings with Poor Medical Services 316
Maggot Therapy Technology Transfer and Training 334
First Clinical Study of Maggot Therapy in Kenya 337
Current Status of Maggot Therapy 341
Primary and Secondary Packaging 350
17. Distribution Logistics 363
Medicinal Maggot Distribution Models 364
Lessons from Kenya and Other Low- and Middle-income Countries 369
18. Drone-assisted Medicinal Maggot Distribution in Compromised Healthcare Settings 383
Drones and Their Capabilities 385
Drone Service Design Considerations Specifically for Medicinal Maggot Distribution 390
Case Examples of Drone Technology that Could Meet Medicinal Maggot Distribution Needs 393
Implementation of Drone-assisted Medicinal Maggot Distribution 394
19. The Ethics of Maggot Therapy 405
Animal Ethics and the Humane Treatment of Medicinal Maggots 407